"Assisted suicide is a matter of individual conscience"
Regarding "A better end,"
(Article, Jan. 3/10): The AMA's rigid opposition to assisted suicide leaves me shaking my head in sad bewilderment. In my 25 years as a surgeon, I have never understood the cruel self-righteousness that drives some doctors to insist on squeezing every last possible heartbeat out of a dying patient, at whatever cost to the patient in pain, humiliation, dehumanization and helplessness.
There's more than physical pain that makes a lingering death from cancer or a relentless degenerative disease unbearable for some patients. The progressive loss of independence, the progressive immobility, the humiliation of incontinence or uncoordination or mental deterioration (perhaps heightened by analgesics), even the heartache of seeing the nest egg one has spent a lifetime accumulating for one's family go up in smoke as doctors labor to prolong one's dying -- all of that can make those final weeks or months of "supportive care" into a living hell for some people.
Certainly there are people who cling to life, who are grateful for drugs and psychotherapy; that is their right, and I am glad such services are available for them. There are others, and I am one, whose greatest terror is to be confronted in my last days with an arrogant zealot of a physician who tells me that however miserable I am, however much I hate what my life has become, I may not die because he forbids it. How does anyone call himself a physician who dares to refuse to help end such suffering?
As in the abortion debate, the question of assisted suicide is a matter of individual conscience. A physician's role should be to alleviate suffering, not officiously prolong life against the individual's wishes. Of course, no one must be coerced into ending his life; but no one should be forced to remain alive when to do so only compounds his misery.
Neither the federal government, nor the AMA, nor any self-proclaimed ethicist has any right injecting a prejudice into either side of the question, because this is a question that can be answered only by the patient and his family, with the help and guidance of a caring physician.
--Stephen D. Leonard, MD
Atlanta
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Physicians must demand "what is scientifically and morally right" and reject expediency
We physicians are responsible for making sure that patients receive optimal, scientifically based care.
First, we have allowed ourselves to be referred to as "health care providers" and now are lumped in with everybody and anybody who claims "medical knowledge."
Second, nonphysicians are assuming the role of physicians in the health care system. Third, more and more medical schools include complementary medicine in their curriculums.
Our medical schools are deviating from scientifically based medicine. There is not enough time in the medical curriculum to teach medical students all scientifically based medicine. How is it that time is allotted for topics for which there is no scientific basis. Theories and practices in alternative medicine change from day to day and week to week.
It is the responsibility of all physicians, especially those in medical centers, to make sure that scientifically based high-quality medical care is available for their patients and that the patients have access to the best trained medical professional, a physician. When will physicians begin to demand what is scientifically and morally right rather than what is expedient in a politically correct day and age?
--Richard F. Lockey, MD
Tampa, Fla.
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There are several paths to managed care's "doctor hell"
Regarding "Physicians risk 'losing their souls' by going along with managed care"
(Letters, Dec. 20, 1999): The letter by Thomas J. Romano, MD, PhD, contains such an eloquent description of "the simple path less traveled" that it is worth reprinting for occasional readers.
He writes, "Doctors who passively go along with managed care and the government with regard to health care decision-making are also at risk for losing their souls and betraying their Hippocratic oath. There is clearly a conflict of interest to serve two masters -- the third-party payer and the patient."
He goes on to write, "I do not understand why physicians don't simply refuse to betray their sacred trust and deal only with the patients, leaving the third parties out of the medical care equation. No other strategy can possibly work."
Well said, Dr. Romano. There are three reasons that we doctors risk burning in "doctor hell" by participating in managed care contracts.
Most have the justifiable fear that we will be unable to practice because patients will be effectively prohibited from seeing us. Some are motivated by greed, actually finding opportunities in the system to add to our power or wealth. Finally, there are those of us who simply do not understand or acknowledge the unavoidable conflict of interest. Fear, greed and ignorance ... not a pretty sight.
--Joseph N. Michelotti, MD
Elgin, Ill.
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